Crybaby Café: Help for Reluctant Nursing
Nursing resistance and nursing strikes — brief periods when a baby resists or refuses breastfeeding — are frustrating, disheartening and stressful. Most babies go through a phase of fussy nursing at some point, says Dr. Susan Rothenberg, associate director of obstetrics at Beth Israel Medical Center in New York.
What's going on?
Breastfeeding moms often misinterpret nursing resistance and mistakenly blame dwindling milk supply, Rothenberg says. "Once breastfeeding is well established, inadequate supply is rarely an issue, but a very common misconception," she says.
It's also easy to assume that a baby is ready to give up nursing. But successfully breastfed babies less than 1 year old seldom self-wean, Rothenberg says. Instead, a baby who resists or refuses nursing may be reacting to common, treatable conditions such as hyperlactation, a slow letdown reflex, discomfort, or changes in the mom's diet or hormone levels.
Hyperlactation: Too much of a good thing
Hyperlactation is the result of an overly strong milk letdown reflex that causes milk to flow too quickly and forcibly for a baby to comfortably swallow. Lactation consultant and registered nurse Laura Burnett, a nursing supervisor at Texas Health Harris Methodist Hospital, says hyperlactation can overwhelm nursing infants and send them into a sputtering, coughing tizzy.
How to help: Burnett suggests nursing in a reclined position to relax both mom and baby. If an oversupply of milk is contributing to the problem, try nursing on one breast per feeding. After a few days, the body will reduce its milk production to a more manageable level.
Slow letdown: Going with the flow
A slow milk letdown reflex can frustrate babies, particularly those who receive bottles, which provide instant milk gratification. Babies will latch on momentarily, only to dissolve into a teary tantrum if milk doesn't flow into their mouths within seconds. A fussy baby only contributes to mom's stress and intensifies the problem.
How to help: While tactics like gentle massage, heat, hand expression or pumping can help get milk flowing before feedings, they won't resolve an underlying issue. "It's important to explore reasons for a slow letdown," Burnett says. Returning to work, changing a nursing routine or starting new medication are factors that can contribute, she says.
A slower-than-normal letdown reflex is often a sign of stress or distraction, Rothenberg says. Her advice: "Take time to relax, ignore the chores piling up and focus on your special bond with your baby."
Pain and suffering: Discomfort drama
You may not feel up to eating when you're experiencing pain or tummy troubles, and your baby is no different. Teething, earache, nasal congestion or mouth pain caused by thrush can make nursing difficult.
Occasionally, a baby's dairy protein sensitivity can lead to uncomfortable gas and fussiness at the breast. This is not lactose intolerance, Burnett says, but a sensitivity to milk proteins in the mother's diet.
How to help: If you've ruled out other causes and your little one is still unenthusiastic about nursing, see a pediatrician to check for pain or illness. A dairy-elimination diet can help relieve symptoms of dairy protein sensitivity, Burnett says, but it may take several weeks to see an improvement.
New tastes: A changing menu
If you consume a varied, flavorful diet, your breastfed baby probably does too. Breast milk varies in taste depending on a nursing mom's diet. Hormonal changes resulting from birth control, a resumed menstrual cycle or a new pregnancy can also affect milk's taste.
Most babies show no reaction to these changes. A few will voice their displeasure if they dislike a new taste and temporarily resist nursing.
How to help: Taste variations in milk are generally temporary. If a baby reacts strongly to a particular taste, eliminating the offending food should resolve the problem. Feeding while baby is very sleepy or taking a warm bath, and providing skin-to-skin contact during nursing, can help minimize resistance to breastfeeding during these changes.
Getting back to happy
Pump or hand-express to stay comfortable when your baby refuses to nurse. If it seems like he isn't getting enough to drink, do a wet-diaper count. He's probably taking in enough fluid if you count at least five to six wet diapers a day.
Like most babyhood phases, nursing resistance is usually short-lived. And it has a silver lining: Once you weather this minor breastfeeding storm, you'll be rewarded with more confidence, patience and a better understanding of your breastfeeding babe.
Malia Jacobson is a freelance writer and mom of two.